Take Home Message:
The presence of an athletic trainer in a high school is associated with a lower
rate of injury – especially recurrent injury – in girls’ basketball and soccer.
Concussion diagnosis improved in schools with athletic trainers.

Sport participation,
regardless of level, will always pose some risk of physical injury. In addition
to physical limitations, athletic injury can also cause psychosocial and
economic concerns. In addition to an athletic trainer (AT) providing immediate
medical attention to an injury, they can also mitigate risk of sport
participation through proper emergency planning; implementation of prevention
programs; monitoring of health and safety measures for weather, equipment, and
playing conditions; and determining when an athlete is ready for return to
activity post-injury. To investigate this impact of having an AT on site, the
authors compared injury surveillance data from girls’ basketball and soccer
between high schools with and without an AT. Between the 2006/07 and 2008/09
academic years, data were collected via the High School Reporting Information Online (RIO) in high schools with an AT and Sports Injury Surveillance System (SISS) in Chicago public high schools without
an AT. Schools with ATs willing to participate in the RIO system were
stratified by size and geographical location and investigators randomly
selected 100 schools from across the country. For these schools, ATs logged
weekly injury and athletic exposure reports. An athletic exposure was defined
as participation in either a practice or a game. An injury was defined as one
that occurred during sanctioned practice or competition, required medical
attention by an AT or physician, and resulted in a time-loss from activity of
at least 1 day. For SISS schools, coaches reported injuries and participation
to determine athlete exposure. For this system, an athletic exposure was
defined as athlete participation in a complete or partial practice or
competition and an injury was defined as time-loss from a practice or
competition. Research assistants reviewed injury reports immediately after each
week and scheduled follow-up interviews to obtain more detailed information. For
both sports, the overall injury rate was higher in schools without an AT than
in schools with an AT. Additionally, among schools without an AT, the rate of
recurrent injury in both sports were ~6 times higher in girls’ soccer and ~3
times higher in girls’ basketball. Most notably, rates of concussions in both
sports were higher and comprised a higher proportion of all reported injuries
in schools with an AT.

Numerous organizations, including the National
Athletic Trainers’ Association, American Medical Association, American Academy
of Family Physicians, and the American Academy of Neurology recommend the
presence of athletic trainers in schools. In a novel approach, the authors of
this study produced evidence supporting the clinically meaningful impact that
ATs may have on communities. While injury rates – especially recurrent injuries
– were less common in schools with an AT, concussions were more commonly
reported. The authors
discussed that these results emphasize the importance of AT services not only
for immediate attention to injuries, but to also prevent recurrent injuries and
improve concussion diagnosis and care. Furthermore, ATs likely treat a portion
of non-time-loss injuries and prevent those from resulting eventually in a cessation
from activity. Most important to this discussion is the socioeconomic factor associated with a school’s
capabilities to fund and provide AT services. Schools in more affluent
geographical areas likely have better access to AT services and physicians,
specialists, and other clinicians who comprise the sports medicine team. Athletes
in socioeconomically disadvantaged areas may either lack access and/or
resources to seek medical care, even for more serious injuries. It can be
strongly argued that these schools are where ATs are most needed. It is
important to keep in mind that this study cannot demonstrate that an AT is the
cause of these better outcomes. The schools with ATs were selected to be
representative of high schools in the United States while the schools without
ATs were all from an inner-city public school district. It would be beneficial
if future investigators collected data in similar schools with and without an
AT. Despite this limitation, this study offers compelling evidence supporting
an array of position statements that ATs should be available to student
athletes.

Questions for Discussion: How would you use this information to promote AT services where none
exist?

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